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General NPI Number Information
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NPI Number | 1669042479
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Entity Type | Individual
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Provider Name | MOLLY ALLEGRA MARTIN MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 480 GALLETTI WAY
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City | SPARKS
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State | NV
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Zip | 89431-5544
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Country | US
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Telephone | 775-982-8870
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Fax | 775-982-8871
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Provider Business Mailing Address
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Address Line | 1155 MILL ST # MCM-14
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City | RENO
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State | NV
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Zip | 89502-1576
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Country | US
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Telephone | 775-982-5262
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Fax | 775-982-8871
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 26852
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10659-C
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License Number State | NV
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